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Page Contents: Confidentiality problems when mixing couples counseling with individual psychotherapy.                    

 

After years of ongoing issues with our relationship, my wife started therapy about six months ago. She was really pushing me to start seeing [her psychotherapist] as well, to deal with my personal issues (which she believes is the root of our problems) After about 5-6 sessions into to her therapy, I began to accompany her for a few couples sessions. I then called to set up ongoing individual sessions. He told me that he didn’t feel comfortable seeing me because he didn’t think he could be impartial. He encouraged me to start seeing his wife (also a psychotherapist) instead. He explained that each person needs to feel as though he or she has someone “in his corner.” I understood that, but thought that he should be professional enough to avoid becoming impartial. . . . My overall concern about this issue was how he could effectively counsel a couple without seeing and understanding both people. He assured me that he and his wife would compare notes, but it’s hard for me to trust in that process. I also thought about how common it is for couples and families to share the same therapist. To make this more stressful, I now felt trapped into having to see his wife, who may or may not be the right therapist for me. Then what? Would I have to see someone else, and would they then be expected to visit with my wifes therapist to compare notes?! It just didn’t seem to make sense. Since then, I’ve had about 10 sessions with his wife, and am at the point where I don’t feel as though she’s right for me. Even is she was, I wouldn’t feel comfortable with having to pay double ($290 per hour)to see her and her husband, when other couples are paying for one therapist. I’m stuck and am not sure where to go with this. I would like to be able to find another therapist, but am not sure how to best handle the couples counseling.

 
In answer to one previous question, I say that the function of marriage counseling is to create a safe and respected environment in which the husband and wife can communicate with each other without hostility. If, after understanding the needs and desires of the other, one person refuses to accommodate the other, then individual psychotherapy can be prescribed, so as to uncover and heal the cause of the resistance to fair and charitable cooperation.

Similarly, in answer to another question, I say that sometimes, when a husband and wife are being seen in marriage counseling, the counselor may occasionally arrange to see one or both individuals in individual sessions. Usually, to avoid clinical disaster, these individual sessions are conducted under the rule that there will be no secrets, and that anything spoken in the individual sessions must be brought into the joint counseling. If either person has the sort of psychological problems that would warrant individual psychotherapy under strictly confidential conditions, the individual(s) should be referred to a separate psychotherapist, someone who has no connection to the marriage counseling.

Now, in your case, your wife began her own individual psychotherapy, you joined her for some sessions of marriage counseling, and then you requested your own individual psychotherapy. Ultimately, then, you were asking for three forms of treatment, not two: your wife’s individual psychotherapy, marriage counseling, and your own individual psychotherapy.

In all of this, though, the concern should not be about impartiality because marriage counseling must be a cooperative process, not an adversarial process. The real concern must be for confidentiality, in any treatment modality.

If one psychotherapist were to see you and your wife individually in addition to seeing you both as a couple, steps have to be taken to make sure that “secrets” emerging from the individual psychotherapy do not obstruct the couples sessions. Everything must come out into the open in the marriage counseling. There has to be an open agreement here about a waiver of confidentiality regarding information obtained in individual sessions. If either you or your wife did not feel comfortable with this, then you should be seeing a marriage counselor with no connection whatsoever to any of the individual psychotherapy.

If one psychotherapist were to see both you and your wife, each in individual psychotherapy, information obtained from your wife in her sessions cannot be revealed to you without her written permission, and vice versa.

Under these conditions, your wife’s psychotherapist chose to refer you for individual psychotherapy to someone else. Even though, technically, he gave you the wrong reasons, he made a clinically acceptable decision—at least, to a point. By referring you to his wife, however, rather than to some other person with no intimate connection to him, he opened the possibility of a breach of your confidentiality. If he and his wife “compare notes”—even casually—without your written authorization, they will make an ethical violation that, with your formal complaint to their licensing boards, could cause them to lose their licenses.

As for the referral itself, no client is bound to accept treatment from anyone referred by a psychotherapist. In fact, if a psychotherapist makes a referral, several names should be provided so that the client has a choice. If only one name is provided, that, too (if it can be shown to have a coercive quality) could be construed as a violation of professional ethics.

 


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Raymond Lloyd Richmond, Ph.D.
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